HIV AIDS News [International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

The goal of antiviral therapy is to restrict viral replication by reducing viral
load to below detectable levels. If the virus cannot replicate due to the presence
of potent antiretroviral treatment, then it cannot produce the mutations necessary
for the development of resistance. Reducing blood virus levels as low as
possible, for as long as possible, maximises long-term clinical benefit and
prevents resistance.
To achieve this, optimal antiretroviral therapy -- consisting of a
combination of the most potent drugs available, taken at maximum tolerated
doses right from the start -- should be prescribed. This strategy maximises
suppression of HIV and limits its ability to reproduce, thereby preventing it from
accumulating the mutations necessary for resistance.
Sequential Therapy Should Not Be Prescribed
Further analysis from Protocol 035 presented by Dr. Gulick at the
ICAAC meeting showed that: adding a protease inhibitor to an existing two-drug
regimen is not as effective as starting on triple therapy with CRIXIVAN and at
least one other antiretroviral medication that patients had not previously taken.
"Delayed or sequential triple therapy clearly produced more modest
antiviral effects than initially starting drug therapy with a potent protease inhibitor
and two nucleoside analogues," Dr. Gulick said. "This study demonstrated the
need to begin treatment with triple therapy including a potent protease inhibitor,
because adding one protease inhibitor to a failing two-drug regimen of
nucleoside analogues is clearly suboptimal treatment. Adding one drug to a
failing regimen will untimately cause the new drug to fail also."